丙戊酸钠合并碳酸锂治疗反复躁狂发作的长期疗效及安全性  

Effect and safety of combination therapy of valproate with lithium on recurrent mania

作　　者：徐文炜[1] 王学庆[2] 陈彩霞[1] 李骥[1] 

机构地区：[1]无锡市精神卫生中心精神科,214151 [2]无锡市精神卫生中心防治康复科,214151

出　　处：《中华精神科杂志》2007年第2期86-89,共4页Chinese Journal of Psychiatry

摘　　要：目的探讨丙戊酸钠合并碳酸锂治疗反复躁狂发作的长期疗效及安全性。方法收集各类双相躁狂发作患者105例,分为碳酸锂组、丙戊酸钠组和碳酸锂+丙戊酸钠组(以下简称合并治疗组),每组各35例。急性期治疗6周后随访5年以上。随访者不干预患者治疗。基线及疗效采用倍克-拉范森躁狂量表(BRMS)评定。随访内容包括复发次数、药物剂量、长期疗效及安全性。结果完成随访105例。急性期治疗后 BRMS 减分率:碳酸锂组(43±29)%;丙戊酸钠组(42±27)%;合并治疗组(58±25)%,三组间的差异有统计学意义(F=3.579,P=0.031)。5年内躁狂复发次数:碳酸锂组(3.5±1.8)次,丙戊酸钠组(3.5±2.2)次,合并治疗组(2.0±1.5)次,三组间的差异有统计学意义(F=7.387,P=0.001);抑郁复发次数:碳酸锂组(2.1±2.4)次,丙戊酸钠组(2.1±2.6)次,合并治疗组(1.4±1.7)次,三组间的差异无统计学意义(F=1.313,P=0.273)。合并治疗组与其他两组疗效的差异主要在快速循环型(F=4.120,P=0.033)。合并治疗组的碳酸锂及丙戊酸钠剂量均分别明显低于其他两组(P<0.01;P<0.001)。三组总体不良反应的差异无统计学意义。结论丙戊酸钠合并碳酸锂用于双相情感障碍的维持治疗能减少躁狂的复发率,安全性较高。Objective The study was to explore the effectiveness and safety of chronic combination treatment of valproate with lithium on recurrent mania.Method All 105 patients with mania-onset were randomly assigned to receive sodium valproate plus lithium （ n = 35 ）, and monotherapy with lithium （n =35） or sodium valproate （n = 35）, and were followed up for 5 years. At baseline, the symptom was evaluated with the Bech-Rafaelsen Mania Rating Scale （BRMS）. The drug dosage, times of relapse, effects and safety was compared among the three groups. Results After the acute therapy, the reductions in BRMS score were （43 ± 29） % in lithium group, （42 ± 27 ） % in valproate group, and （58 ± 25 ） % in combination group, respectively, with significant differences between the three groups （F = 3. 579, P = 0. 031 ）. At followed-up, the relapse times was significantly less in combination group than that in lithium and valproate group（mean times of 2. 0 ± 1.5, 3.5 ± 1.8, and 3.5 ± 2. 2, P = 0. 001 ）. The combination therapy had better effectiveness especially in patients with rapid cycling bipolar disorder （F = 4. 120, P = 0. 033 ） than the other two monotherapy group. The mean dosage of single drug in combination group was significantly lower than that in lithium and valproate group （ P 〈 0. 01 ; P 〈 0. 001 ） . There were no significantly statistic differences on side-effects among three groups. Conclusion It is suggested that the efficacy of combination therapy of valproate with lithium on mania be better than monotherapy with lithium or valproate with the same safety.

关 键 词：双相情感障碍 丙戊酸 碳酸锂 随访研究 

分 类 号：R749.4[医药卫生—神经病学与精神病学]